Scopolamine Prevents Dreams during General Anesthesia

Background Dreaming during anesthesia is not a well-understood phenomenon. Anticholinergic drugs are used in anesthesia as premedication, but their use to decrease the incidence of dreams and psychological adverse reactions after anesthesia is not well established. The authors therefore studied the efficacy of intramuscular atropine and scopolamine for the prevention of dreams during general anesthesia with propofol and nitrous oxide. Methods Healthy women undergoing minor gynecologic surgery were randomly assigned to receive 2.5 microg/kg scopolamine or 10 microg/kg atropine intramuscularly (n = 50/group). In both groups, anesthesia was induced and maintained with propofol as a 2.5-mg/kg bolus, followed by 12 mg x kg(-1) x h(-1) as a continuous infusion and 70% nitrous oxide in oxygen. Two interviews regarding dreaming activity and characteristics were conducted at 20 min and 6 h after surgery. Results None of the patients in the scopolamine group and 47% of the patients in the atropine group reported the occurrence of dreams 20 min after recovery. The results were similar at 6 h: 6% of the scopolamine group and 43% of the atropine group reported dream activity. No differences in sedation or anesthetic requirements were found. Conclusions Previous studies in animals and humans suggest that dreams are affected by drugs acting on the central cholinergic system. The current results suggest that intramuscular scopolamine prevents dreams or dream recall in healthy young women undergoing short elective surgery with propofol-nitrous oxide anesthesia.

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Factors affecting general or regional anesthesia preference in patients with elective surgery

Medical Science and Discovery ◽

10.36472/msd.v7i7.403 ◽

2020 ◽

Vol 7 (7) ◽

pp. 570-574

Author(s):

Esra Adıyeke ◽

Levent Adıyeke

Keyword(s):

General Anesthesia ◽

Regional Anesthesia ◽

Significant Positive Correlation ◽

Elective Surgery ◽

Education Level ◽

Foot Surgery ◽

Factors Affecting ◽

Positive Correlation ◽

The Mean ◽

To Receive

Objective: This study aimed to investigate the factors that affect the preference of the anesthesia method in patients who were indicated for general or regional anesthesia. Material and Methods: A descriptive questionnaire was used to evaluate the opinions of 123 patients who were planned to undergo elective surgery in the orthopedics and traumatology outpatient clinic between January 2018 and June 2019. Results: 73 women (%59) and 50 men (%41) participated in the study. The mean age was 58.62±11 years. General anesthesia was preferred in 58% of the patients. The most common reason for rejection was that the patients who preferred general anesthesia did not want to receive visual and auditory stimuli during the surgical procedure. There was a significant positive correlation between education level and regional anesthesia preference rate. There was a significant positive correlation between the regional anesthesia preference rate of patients receiving hand and foot surgery indications. Conclusion: The preference of the majority of patients was found to be general anesthesia method. Additionally, the type of surgery and education level of the patients was found to be effective in preference of the anesthesia method.

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INTUBATION FOLLOWING THIOPENTAL-SUCCINYLCHOLINE OR SEVOFLURANE-NITROUS OXIDE ANESTHESIA FOR GENERAL ANESTHESIA IN ELECTIVE SURGERIES IN ADULTS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/1762 ◽

2013 ◽

Vol 2 (52) ◽

pp. 10253-10261

Author(s):

Kameswara Rao A.S. ◽

Sai Krishna P ◽

Harinath Babu V ◽

P. Sankara Prasad

Keyword(s):

Nitrous Oxide ◽

General Anesthesia ◽

Oxide Anesthesia

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Influence of Methylenetetrahydrofolate Reductase Gene Polymorphisms on Homocysteine Concentrations after Nitrous Oxide Anesthesia

Anesthesiology ◽

10.1097/aln.0b013e318178820b ◽

2008 ◽

Vol 109 (1) ◽

pp. 36-43 ◽

Cited By ~ 46

Author(s):

Peter Nagele ◽

Barbara Zeugswetter ◽

Caspar Wiener ◽

Hansjörg Burger ◽

Michael Hüpfl ◽

...

Keyword(s):

Nitrous Oxide ◽

Vitamin B12 ◽

Methylenetetrahydrofolate Reductase ◽

Elective Surgery ◽

Plasma Concentrations ◽

Mthfr Gene ◽

Plasma Homocysteine ◽

Outcome Variable ◽

Wild Type ◽

Oxide Anesthesia

Background Mutations in the methylenetetrahydrofolate reductase (MTHFR) gene (677C>T, 1298A>C) cause elevated plasma homocysteine concentrations and have been linked to fatal outcomes after nitrous oxide anesthesia. This study tested the hypothesis that patients with common MTHFR 677C>T or 1298A>C mutations develop higher plasma homocysteine concentrations after nitrous oxide anesthesia than wild-type patients. Methods In this prospective, observational cohort study with blinded, mendelian randomization, the authors included 140 healthy patients undergoing elective surgery. All patients received 66% nitrous oxide for at least 2 h. The main outcome variable, plasma total homocysteine, and folate, vitamin B12, and holotranscobalamin II were measured before, during, and after surgery. After completion of the study, all patients were tested for their MTHFR 677C>T or 1298A>C genotype. Results Patients with a homozygous MTHFR 677C>T or 1298A>C mutation (n = 25) developed higher plasma homocysteine concentrations (median [interquartile range], 14.9 [10.0-26.4] microm) than wild-type or heterozygous patients (9.3 [7.5-15.5] microm; n = 115). The change in homocysteine after nitrous oxide anesthesia was tripled in homozygous patients compared with wild-type (5.6 microm [+60%] vs. 1.8 microm [+22%]). Only homozygous patients reached average homocysteine levels considered abnormal (> 15 microm). Plasma 5-methyl-tetrahydrofolate concentrations increased uniformly by 20% after nitrous oxide anesthesia, indicating the inactivation of methionine synthase and subsequent folate trapping. Holotranscobalamin II concentrations remained unchanged, indicating no effect of nitrous oxide on vitamin B12 plasma concentrations. Conclusions This study shows that patients with a homozygous MTHFR 677C>T or 1298A>C mutation are at a higher risk of developing abnormal plasma homocysteine concentrations after nitrous oxide anesthesia.

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Long-term Impairment of Acquisition of a Spatial Memory Task following Isoflurane–Nitrous Oxide Anesthesia in Rats

Anesthesiology ◽

10.1097/00000542-200402000-00020 ◽

2004 ◽

Vol 100 (2) ◽

pp. 309-314 ◽

Cited By ~ 197

Author(s):

Deborah J. Culley ◽

Mark G. Baxter ◽

Rustam Yukhananov ◽

Gregory Crosby

Keyword(s):

Nitrous Oxide ◽

Spatial Memory ◽

General Anesthesia ◽

Age Groups ◽

Memory Task ◽

Aged Rats ◽

Adult Rats ◽

Spatial Memory Task ◽

Oxide Anesthesia

Background The authors demonstrated previously that isoflurane-nitrous oxide anesthesia attenuates performance improvement on an already-learned spatial memory task and that the effect persists for weeks. This experiment was designed to test the hypothesis that learning of new information is particularly susceptible to prolonged disruption after general anesthesia. Methods Six- (n = 5) and 20- (n = 5) month-old male Fischer 344 rats were anesthetized for 2 h with 1.2% isoflurane, 70% nitrous oxide, and 30% oxygen. Age-matched control rats received 30% oxygen and 70% nitrogen (n = 5 per group). Rats breathed spontaneously, and anesthetic and oxygen concentrations were measured. Spatial learning was assessed daily for 21 days on a 12-arm radial maze (RAM) beginning 48 h after anesthesia. In a post hoc experiment to examine locomotion, swim speed was assessed in a separate group of identically treated rats (n = 3 per group) for 4 days beginning 48 h after anesthesia. Results Aged rats were slower to complete the maze, made fewer correct choices before first error, and made more errors at baseline than young rats (P < 0.05). Anesthesia worsened maze performance in both age groups, as evidenced by increased time to complete the maze and a decreased number of correct choices before first error (P < 0.05), but there were no statistically significant differences in total number of errors. Interestingly, there were no age-by-anesthesia interactions. Aged rats swam slower than adult rats (P < 0.001), but there were no differences between the control and anesthesia groups. Conclusions Isoflurane-nitrous oxide anesthesia is associated with a persistent deficit in RAM performance that is not explained by impaired locomotion. This impairment occurs in adult and aged rats, indicating that it is not an age-specific phenomenon. Thus, RAM performance is altered after general anesthesia for longer than predicted by the pharmacology of the drugs used, which, by inference, suggests a long-term deficit in learning/memory.

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Dreaming during Anesthesia and Anesthetic Depth in Elective Surgery Patients

Anesthesiology ◽

10.1097/00000542-200701000-00010 ◽

2007 ◽

Vol 106 (1) ◽

pp. 33-42 ◽

Cited By ~ 61

Author(s):

Kate Leslie ◽

Hannah Skrzypek ◽

Michael J. Paech ◽

Irina Kurowski ◽

Tracey Whybrow

Keyword(s):

Bispectral Index ◽

Elective Surgery ◽

Near Miss ◽

Depth Of Anesthesia ◽

Dream Recall ◽

Sleep State ◽

Anesthetic Depth ◽

Almost All ◽

To Receive ◽

First Interview

Background Dreaming reported after anesthesia remains a poorly understood phenomenon. Dreaming may be related to light anesthesia and represent near-miss awareness. However, few studies have assessed the relation between dreaming and depth of anesthesia, and their results were inconclusive. Therefore, the authors tested the hypothesis that dreaming during anesthesia is associated with light anesthesia, as evidenced by higher Bispectral Index values during maintenance of anesthesia. Methods With approval, 300 consenting healthy patients, aged 18-50 yr, presenting for elective surgery requiring relaxant general anesthesia with a broad range of agents were studied. Patients were interviewed on emergence and 2-4 h postoperatively. The Bispectral Index was recorded from induction until the first interview. Dream content and form were also assessed. Results Dreaming was reported by 22% of patients on emergence. There was no difference between dreamers and nondreamers in median Bispectral Index values during maintenance (37 [23-55] vs. 38 [20-59]; P=0.68) or the time at Bispectral Index values greater than 60 (0 [0-7] vs. 0 [0-31] min; P=0.38). Dreamers tended to be younger and male, to have high home dream recall, to receive propofol maintenance or regional anesthesia, and to open their eyes sooner after surgery. Most dreams were similar to dreams of sleep and were pleasant, and the content was unrelated to surgery. Conclusions Dreaming during anesthesia is unrelated to the depth of anesthesia in almost all cases. Similarities with dreams of sleep suggest that anesthetic dreaming occurs during recovery, when patients are sedated or in a physiologic sleep state.

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Stress hormone changes in general anesthesia of long duration: isoflurane–nitrous oxide vs sevoflurane–nitrous oxide anesthesia

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2005.03.009 ◽

2005 ◽

Vol 17 (8) ◽

pp. 586-591 ◽

Cited By ~ 35

Author(s):

Tomoki Nishiyama ◽

Koichi Yamashita ◽

Takeshi Yokoyama

Keyword(s):

Nitrous Oxide ◽

General Anesthesia ◽

Stress Hormone ◽

Long Duration ◽

Oxide Anesthesia

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489 Pivotal Phase 3 Study of FT218, a Once-Nightly Sodium Oxybate Formulation, in Patients With Narcolepsy: REST-ON Primary Results

SLEEP ◽

10.1093/sleep/zsab072.488 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A193-A193

Author(s):

Clete Kushida ◽

Colin Shapiro ◽

Thomas Roth ◽

Michael Thorpy ◽

Russell Rosenberg ◽

...

Keyword(s):

Adverse Reactions ◽

Sleep Latency ◽

Sodium Oxybate ◽

Mean Difference ◽

Pivotal Phase ◽

Double Blind ◽

Old Patients ◽

Maintenance Of Wakefulness Test ◽

To Receive ◽

Clinical Global Impression Improvement

Abstract Introduction Sodium oxybate (SO) is an effective treatment for patients with narcolepsy; however, currently available SO formulations require twice-nightly dosing. The purpose of this study was to evaluate efficacy and safety of FT218, an investigational once-nightly controlled-release SO formulation, for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy types 1 (NT1) and 2 (NT2). Methods This was a randomized, double-blind, placebo-controlled, multicenter study in patients with narcolepsy ≥16 years old. Patients were randomized 1:1 to receive FT218 or matching placebo: 4.5 g/night for 1 week, 6.0 g/night for 2 weeks, 7.5 g/night for 5 weeks, and 9.0 g/night for 5 weeks (maximum treatment duration, 13 weeks). Coprimary endpoints were mean sleep latency (minutes) on maintenance of wakefulness test (MWT), Clinical Global Impression-Improvement (CGI-I) of sleepiness, and weekly number of cataplexy attacks (NCAs; NT1 only). Results A total of 212 patients were randomized and received study treatment (FT218, n=107; placebo, n=105). FT218 showed significant (P<0.001) improvement vs placebo in mean sleep latency on MWT for all evaluated doses; LS mean difference (minutes) between FT218 and placebo was 6.13 at 9.0 g (week 13), 6.21 at 7.5 g (week 8), and 4.98 at 6.0 g (week 3). A higher proportion of patients receiving FT218 were much/very much improved on CGI-I vs placebo (72% vs 31.6% at 9.0 g; 62.6% vs 22.8% at 7.5 g; and 40.1% vs 6.1% at 6.0 g; all P<0.001). LS mean difference between FT218 and placebo in mean weekly NCAs was significant (P<0.001) for all doses: −6.65 at 9.0 g, −6.27 at 7.5 g, and −4.83 at 6.0 g. The most common adverse reactions were nausea, vomiting, headache, dizziness, enuresis, and decreased appetite. Conclusion All evaluated doses of FT218 showed significant improvement vs placebo in mean sleep latency on MWT, CGI-I, and weekly NCAs. FT218 was generally well tolerated and the most common adverse events were consistent with known side effects of SO. Support (if any) Avadel Pharmaceuticals.

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